C-sections cost over 60% more than vaginal births

Nearly one in four Canadian babies delivered by C‑section in 2002–2003 April 26, 2006—Hospitals typically spend over 60% more to care for a mother who has a caesarean section birth than they do for a mother who has a vaginal delivery, according to a new report by the Canadian Institute for Health Information (CIHI). In 2002–2003, average hospital costs ranged from about $2,800 for vaginal deliveries to $4,600 for C-sections and $7,700 for major procedures, such as hysterectomies and surgical repairs following delivery. Canada’s C‑section rate was 24% in 2002–2003, up from 17% in 1992–1993. “While many more women have vaginal deliveries than have C-sections in Canada, the mix is shifting over time,” says Jennifer Zelmer, Vice-President of Research and Analysis at CIHI. “Changes in birthing practices clearly have important implications for mothers, their babies and their care providers. This report shows that these trends may also affect how much hospitals spend on obstetrical care.” Giving Birth in Canada: The Costs, the final report in CIHI’s three-part series on having a baby in Canada, also shows that about one of every ten dollars that hospitals spend on care for patients with overnight stays goes toward childbirth and newborn care. Hospitals outside Quebec and rural Manitoba (for which comparable data are not available) spent about $821 million on pregnancy and delivery stays in 2002–2003 (6% of total inpatient spending) and $361 million on newborn care (4% of total inpatient spending). These totals do not include most professional fees paid to physicians or midwives through government insurance plans. Spending on hospital care for newborns Hospital costs for newborn care tend to vary depending on the baby’s health and the care required. Relatively few babies weighing less than 750 grams (about a pound and a half) are born each year (less than 0.1% of hospital births, outside of Quebec and rural Manitoba in 2002–2003). However, these infants stayed an average of 113 days in hospital, and the hospital cost for their care was almost $118,000 on average. In contrast, about 6 in 10 newborns are delivered vaginally with a normal birth weight. These babies stayed an average of two days in hospital, and their care cost about $800 each in 2002–2003. Babies who need extra care or monitoring are sometimes cared for in neonatal intensive care units (NICUs). Hospitals spent $9,700 on average to care for babies admitted to NICUs in 2002–2003 (based on data from 27 hospitals). About 13.6% of babies were admitted to a NICU in that year, up from 12.6% in 1994–1995 (excludes those from Quebec and rural Manitoba). “Newborns are more likely to spend time in a neonatal intensive care unit than in the past,” says Dr. Jan Christilaw, an obstetrician/gynecologist at British Columbia’s Women’s Hospital and Health Centre and a member of the report’s Expert Advisory Panel. “In some cases, preventive or early intervention strategies before and during pregnancy may reduce the need for this type of care.” - MORE - Variations in funding across Canada All provincial and territorial health insurance plans cover medically necessary hospital and medical care during pregnancy and childbirth, although in some cases mothers and their babies may need to travel for care. Public funding of other services varies across the country, sometimes even within a province or territory. For example, coverage for expanded prenatal screening for inherited disorders and for in-vitro fertilization differs between jurisdictions. Likewise, midwifery services are publicly funded in British Columbia, Manitoba, Ontario, Quebec, the Northwest Territories and Nunavut. Some other provinces regulate midwifery, but families have to pay for the services out-of-pocket. In Alberta, where midwifery services are not usually publicly covered, typical costs are about $2,500 for such services. According to Statistics Canada, midwives provided care for 3% of mothers with children aged 0 to 11 months across Canada in 2000–2001. More report findings

• Women are spending less time in hospital when giving birth than they did 20 years ago. In 1984–1985, the average length of stay for all deliveries was over five days. This dropped to three days in 1994–1995. More recently, this trend has stabilized somewhat. The average length of stay in 2003–2004 was about two days for vaginal births and four days for C-sections.
• Physicians provide the majority of obstetrical services in Canada. In 2002–2003, physicians received $154 million from government fee-for-service payment plans for obstetrical services (excluding therapeutic abortions), about 1.3% of government payments for all physician services. Vaginal births accounted for 78% of such fee-for-service payments to family physicians and general practitioners who provide obstetrical care, and 58% of payments to obstetricians/gynecologists.

About CIHI: The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information.

CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.